Diagnosis: psoriatic arthritis.
Treatment: Stelara.
The insurer denied Stelara SQ (subcutaneous) 90 mg.
The health plan's determination is overturned.

The patient is a woman with psoriasis and psoriatic arthritis. The patient has been on Stelara 90 milligrams (mg) every 8 weeks (w) and is stable.

Stelara subcutaneous (SQ) 90mg is medically necessary for this patient.
The patient has psoriasis and psoriatic arthritis (PsA) and has been on Sstelara 90 mg every 8 w since. For patients with psoriasis who weigh <= (less than or equal to) 100 kg(kilogram), Stelara is usually started at 45 mg at 0 and 4 weeks, and then every 12 weeks thereafter. However, some patients may require doses of 90 mg or maintenance dosing every 8 weeks. Given that this patient has both psoriasis and PsA, it's medically necessary to continue Stelara 90mg every 8w. She was previously on 45 mg every 12w but her PsA was not as well controlled. She is stable on this dose and tolerating it well.

In 2019, the Journal of the American Academy of Dermatology published the joint guidelines of care for the management and treatment of psoriasis with biologics and stated that for patients with psoriasis who have had an inadequate response to Stelara (45 or 90mg every 12w), a trial of 90 mg for patients <=100 kg and/or maintenance therapy every 8 w is indicated.